The word Laser is an acronym that stands for Light Amplification by Stimulated Emission of Radiation.
The different lasers used for facial abrasion are mainly ultra-pulse CO2 lasers and Erbium lasers.
The laser beam acts by destroying, by controlled photo-vaporization, the superficial layer of the skin, i. e. the epidermis and can reach the superficial dermis depending on the desired purpose: it is a controlled burn.
This computerized control of the depth of the vaporization is done by the number of passes of the laser beam, the energy emitted, its density. It depends on the importance of the defect to be corrected, the area to be treated, the quality of the skin and the desired purpose.
The destroyed surface layer will then be restored thanks to natural healing phenomena from the islets of the basal dermo-epidermal membrane and the pilosebaceous annexes contained in the deep dermis: this is reepidermisation or reepithelialisation.
This implies a healing time where the skin remains fragile and requires careful care.
It is this restoration of the skin surface that will create a smoother appearance: it is a smoothing that has the virtue of erasing, more or less, the imperfections that one wants to treat.
In addition, dermo-epidermal healing will take place with some retraction of the cutaneous skin, a real cutaneous "tightening" effect, variable and more or less important depending on the case.
Another group of intermediate action lasers is represented by fractionated lasers, CO2 or not, for which the treatments are carried out in three or four sessions. They are less efficient than conventional CO2 or Erbium lasers but significantly more efficient than other lighter processes. Unlike conventional abrasion lasers, they do not destroy the entire epidermis of the skin in one session. They create zones separated from each other in which the epidermis and dermis, more or less deep, are destroyed. As the entire surface is not affected by these wells in one session, the treatment must be repeated three or four times in a row so that the entire surface of the skin is treated. This method of splitting the treatment avoids scabs and complications of conventional lasers.
CO2 fractionated lasers are less efficient than conventional CO2 lasers but do not cause significant complications. They must be performed under local anesthesia and their after-effects are still responsible for a social eviction of four to five days due to scabs. They are indicated in cases of marked skin ageing but are reserved for fair skin. The neck and lower eyelids should be avoided.
Fractionated lasers other than CO2 are slightly less efficient than fractionated CO2 lasers. They must also be performed under local anaesthesia and their after-effects are lighter with only temporary oedema and redness lasting two to three days. They are indicated in cases of early and moderate skin aging. They can be used on all skin types, regardless of colour and on all locations, including eyelids and neck. It is the current classic treatment of skin aging that is intended to be effective, without being aggressive and without risk of complications.
Remodeling or rejuvenation lasers (low-energy lasers or intense pulsed light) are lighter techniques, through a superficial dermo-epidermal thermal action by protecting the epidermis from burning by a cooling system.
The thermal action leads to fibroblastic stimulation and a tiny oedema caused by the inflammatory reaction which leads to remodelling, an improvement in flexibility, texture and skin colour. They are much less aggressive than ultra-pulsed CO2 lasers or Erbium lasers, but their effect is less. They do not lead to any significant complications. The repetition of the sessions, without any anaesthesia, without any social eviction, can be of some interest, resulting in a radiance, an action on the complexion by producing a refreshing effect and an action on fine lines.
Duration of hospital stay
1 to 2 days.
Under local or general anesthesia.
Average length of stay
The operation can be performed on an outpatient basis with a same-day discharge.
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The purpose of the consultation is to assess the request, clarify the indication, inform the patient of what can and what will not be treated and explain all the facts about this type of intervention.
Preoperative skin preparation is important to optimize the result: skin cleansing, fruit acid or vitamin A acid creams, antibiotic coverage, antiherpetic coverage, are sometimes prescribed by your surgeon during the 2 or 3 weeks preceding the procedure to prepare your skin so that it arrives at the time of the procedure in the best possible local conditions.
TYPE OF ANESTHESIA AND HOSPITALIZATION MODALITIES
These modalities are to be discussed with your surgeon, the procedure can be done:
• Under local, locoregional, general or neuroleptanalgesia anesthesia.
• With a hospitalization of one or more days or on an outpatient basis.
Type of anesthesia:
The principle for anaesthesia during laser-abrasion of the face is the search for comfort, both for the patient and for the practitioner. This objective is easier to achieve with general anesthesia or analgesia:
• Classical general anaesthesia
• Analgesia is a local anaesthesia supplemented by tranquilizers administered intravenously.
However, local or truncal anaesthesia may be used:
• Truncal blocks are very well suited for the eyelids and for the median part of the face (forehead, nose, lips and chin). These blocks are efficient and easy to handle. They consist of the injection of an anesthetic product around a sensitive nerve that innervates a cutaneous area: this area is thus anaesthetized for the duration of the procedure.
• Pure local anaesthesia: an anaesthetic product is injected locally subcutaneously to numb the area to be treated. The lateral parts of the face (cheek, temporal region), difficult to access for truncal blocks, respond very well to this technique.
• EMLA anesthetic creams have an interest in thin skins, especially if the abrasion remains high. Progress is expected on this type of anaesthetic cream.
The procedure can be performed "on an outpatient basis", i.e. with a same-day discharge after a few hours of supervision. If a hospitalization, generally quite short, is recommended, the entry is effective the day before or the same morning, with an exit the next day or two days later.
After cleaning and disinfecting the skin and installing the sterile fields, certain precautions are required and are part of the safety instructions that protect against a possible accident involving the orientation of the laser beam and its possible damage.
• Protection of the patient's eyes (lubricated corneal protector), hair, eyelashes and eyebrows, teeth (wet compresses)
• Protection of the eyes of the operator and all persons in the room (glasses).
Laserabrasion is performed using a computerized collimated handpiece. The surgeon directs the laser beam onto the area to be treated; the laser spot, whose size and shape are at the operator's discretion, sprays the skin surface: it is a photo-spray, i. e. a thermal abrasion.
The control of the depth of the vaporization is computerized: it is carried out by varying the emitted energy, its fluence, the density of the laser spot and the number of passes.
This depth depends on the importance of the defect to be corrected, the area to be treated, the quality of the skin and the desired purpose. It is assessed, as is the dermal contraction, after each passage, which allows the parameters to be modified if the surgeon decides to make additional passages.
At the end of the laserbrasion, the dermis is exposed, resulting in bleeding. This dermis must then be covered and protected:
• either by a closed bandage, dry or greasy, to be repeated every day due to the significant oozing
• or by an open bandage which consists in the application of vaseline fat to be repeated several times a day.
Immediately after treatment, abrasion exposes the dermis: this causes redness, oedema and oozing.
Local treatments, based on fats or bandages will be carried out until complete healing, obtained in 10 to 15 days, which requires social eviction. If properly managed by your surgeon, this local care will prevent the appearance of scabs, which even if undesirable, may eventually form and should not be torn off to respect the underlying healing process under way and not run the risk of a possible residual scar.
Appropriate make-up and sun protection are recommended from the 10th day onwards to camouflage an erythema of variable intensity (red or pink appearance of the treated skin for 1 to 2 months, or even longer, which is not a complication but a normal continuation).
A general treatment (analgesic, anti-inflammatory, antibiotic, anti-herpetic, anti-pruritic) is prescribed at the same time.
The skin may be uncomfortable, dry, fragile, irritable, intolerant to usual cosmetics for several weeks. Rashes with redness and heat can occur for a few months.
The purpose of these treatments is to improve, not to achieve perfection. If your wishes are realistic, you should be very satisfied with the result.
After several months, the final result shows a smoother skin, having benefited from a tightening effect with a normal thickness of the epidermis.
• Microbial infection • Acne outbreak
• Milium grains (small white cysts)
• Hyperpigmentation (especially on dark skins): early and almost always transient, it is often due to premature exposure to the sun.
• Hypopigmentation: often permanent, appears less frequently and later
• Persistent redness
• Healing disorders and hypertrophic scars are possible but rare. They show excessive destruction, scratching, failure to respect the fragile re-epidermisation of the beginning of the healing process, an infection that is poorly or late treated.
• Allergy: products used for skin disinfection or care can also cause an allergy, so it is important to consider all the allergies the patient has had in their lifetime.
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